In many modern health care systems there is an established protocol that patients follow for receiving medical treatment when suffering from one or more physical illnesses, injuries, diseases etc. A patient may experience symptoms, determine whether or not to seek medical assistance based on the severity of their symptoms, and then may visit a care provider to ascertain a diagnosis and treatment plan to cure and/or alleviate their symptoms. In some examples, the care provider may render a diagnosis and prescribe a treatment plan for the patient. In other examples, the care provider may decide to refer the patient to a medical expert specializing in a field of medicine related to the patient's illness, disease, injury, etc.
However, in some cases, patients may experience physical symptoms, for which there is no underlying physical cause or medical explanation. This condition is commonly referred to as somatic symptom disorder. Said another way, patients may report subjective experiences of the symptoms associated with one or more diseases, but doctors cannot find an objective verification of the symptoms without a structural problem that would explain subjective patient experiences. These symptoms have been called “Medically Unexplained Symptoms,” or MUS. In these instances, the symptoms may be caused by anxiety, stress, or other mental health disorders, or could be caused by a functional condition for which no effective diagnostic tool exists. However, patients with MUS symptoms unwittingly engage in symptom-amplifying behaviors and thoughts. These types of patients that experience physical symptoms disproportionate to the underlying disease or condition as a result of symptoms amplification, may be referred to in the description herein as somatization patients.
However, many health care providers do not have sufficient information to assess whether the patient's tendency to somitize is contributing to the symptom manifestation, nor do they have access to an evidence-based intervention to help the psychological needs underlying this tendency. It is estimated that approximately 10% of health care associated costs are spent in attempts to diagnose persistent symptoms reported by this population of patients. Thus, the healthcare system is expanding significant resources to diagnose symptoms which are not medically-based. As such, money in the health care system may be wasted by incorrectly diagnosing and treating patients with mental health disorders. More specifically, both patients, health plans, and providers may be spending money on repeat diagnostics and improper treatments. The improper identification, diagnosis, and treatment of somatization patients may be in part due to one or more of the difficulty in distinguishing and identifying somatization patients from other patients with physical conditions at first presentation, convincing somatization patients to engage in mental health therapies, and delivering the proper mental health therapies to the somatization patients.
Somatization patients may be difficult to find and identity for many reasons. Physicians often struggle to identify somatization patients because patients may frequently switch health care providers. Further, somatization patients are often sensitive about their conditions, and in many cases are afraid or unwilling to identify themselves. Further, most somatization patients are unaware of their mental disorder and do not link physical symptoms with health anxiety. Family member of somatization patients, which could be helpful in identifying somatization patients, may have difficulty linking symptoms with a diagnosis to a correct treatment. Excising in-office screeners that may be able to engage with somatization patients via a face-to-face interaction may take too much time to be practical.
Even after identifying a somatization patient, it may be difficult to engage the patient in mental health therapies as treatment for their disorder. First, somatization patients may resist treatment in the form of mental health therapy for several reasons. Somatization patient may feel stigmatized by a mental health diagnosis or a suggestion that their symptoms are “in their head”. Additionally, somatization patients may be concerned with the cost of mental health treatments and the time commitment of weekly hour-long therapy sessions. Further, somatization patients may be concerned with their privacy. Also, somatization patients may be skeptical about the efficacy of mental health therapies in treating their symptoms. This may be in part due to a lack of education about the effectiveness of mental health therapies in treating symptoms, and the general stigma of mental health interventions.
Since physicians are not mental health specialists, and lack the time necessary to learn and administer mental health treatments for somatization patients. Physicians may be uncomfortable referring somatization patients to a mental health specialist and may become concerns that the patient/doctor relationship may be jeopardized if the patient perceives they are not taking the symptoms seriously. The added time the referral could take combined with a lack of information regarding reliable referral sources that can deliver evidence based intervention for somatization patients, may further reduce a physician's propensity for administering mental health referrals.
Thus, health plans themselves, and not just the physicians, may be unable to effectively engage with this patient group. These patients fly under the radar of payers today. They are not on the case management radar because their individual spending is not high enough. They are not actively managed by disease management because they generally do not have one of the key chronic diseases that would make one a target. And these patients do not tend to engage wellness programs because they do not associate themselves with the well and are often quite concerned with their frailty.
The inventors herein have recognized the issues described above and have devised systems and methods for at least partly addressing the issues. In particular, systems and methods for a somatization identification and treatment platform are provided. In one example, a method comprises receiving medical claims data for a plurality of patients, identifying somatization patients based on the received medical claims data, where the somatization patients include patients suffering from one or more physical symptoms that are in excess of demonstrable disease, presenting a symptom support plan to the identified somatization patients via a user interface based on a severity of their disorder, where the symptom support plan may include one or more of educational programs, episodic support, and behavioral health therapy, monitoring identified somatization patients' progress in the symptom support plan, and displaying the patient's progress to a health plan provider.
In this way, the proficiency in identifying somatization patients may be increased. Additionally, somatization patients may be provided with education tools and information about the benefits of receiving behavioral health therapy for treating their disorder. As a result, they may be more inclined to seek treatment options that will more effectively mitigate their symptoms. By more efficiently identifying somatization patients, and increasing their engagement in proper treatment options, the amount of time and money spend on unproductive treatments for these patients may be reduced. As such, health care costs for both health plan providers, and patients may be reduced.
The above summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This summary is not intended to identify key features or essential features of the subject matter, nor is it intended to be used to limit the scope of the subject matter. Furthermore, the subject matter is not limited to implementations that solve any or all of the disadvantages noted above or in any part of this disclosure.